Blog Posts

emergency physician

Envision physician Jeff Gusky, MD, FACEP, lives two lives: one as an emergency physician and the other as a National Geographic photographer, explorer and now television host. His photographs and discoveries have been featured in media and museums around the world – and even on Broadway.

Dr. Gusky, who is an emergency physician at Emergis ER locations in Dallas and Fort Worth, was fortunate to find and photograph a hidden world of World War I, modern underground cities beneath the former trenches in France that once housed tens of thousands of troops at any given time. They were equipped with electricity, railways, telecommunications and the infrastructure of a modern city. One site is more than 25 miles underground in one place, another housed 24,000 troops underground and had a 700-bed hospital. Almost all of these findings are beneath private farmland and unknown to the outside world, even today. Now in complete darkness are thousands of messages that soldiers left behind: notes to loved ones, museum-quality art and inscriptions, names and addresses – a hidden world frozen in time.

The 100-year anniversary of the United States entering World War I was last week. On April 6, an 18-month exhibition of Dr. Gusky’s work opened at The Smithsonian National Air and Space Museum in Washington, D.C. More than 13 million people are expected to visit the exhibition. This short video, which is part of the exhibition, underscores the connection between emergency medicine, art and exploration.

“My mission as an explorer and artist is identical to my mission in the ER: to help people see and avoid danger,” explains Dr. Gusky. “I strive to inspire hope about the future among ordinary citizens by encouraging people to ask questions about modern life we have forgotten how to ask and by helping to create a language for us to talk about how technology and life in cities affects conscience.”

Dr. Gusky’s career as an explorer and artist began on a bleak day in December 1995 at the former Nazi concentration camp Plazow, just outside Cracow, Poland. Acting on a hunch while visiting a memorial near the camp’s entrance, he climbed a nearby hill in knee-deep snow. Approaching the top, a barbed wire fence came into view surrounding a Nazi-era compound: an abandoned building with prison-bar windows next to a set of ovens, ashes still present. In the dim light and silence, Dr. Gusky experienced a strong sense that unspeakable acts of barbarism once occurred there. Guided by intuition, he began photographing what he felt, the same method he uses today.

Since that day, Dr. Gusky has been on a quest to understand why mass murder and terrorism still threatens us. Exploring places in Poland, Belgium, France, Moldova, Ukraine, Transnistria and Romania, where millions of innocent people have been slaughtered in modern times, he has discovered a common thread to every modern mass murder.

“Technology and the inhuman scale of modern life endangers us by making us feel like machines and by disabling our moral compass,” Dr. Gusky said. “My work seeks to help communicate the looming human emergency caused by compromises we make that diminish our humanness.”

Dr. Gusky’s first year of medical school at the University of Washington was spent in Alaska as part of the WAMI (Washington, Alaska, Montana and Idaho) Program, created to inspire students to become country doctors. After graduation, he combined his love of flying and rural medicine and used his plane to reach remote hospital emergency rooms on short notice throughout Texas and Oklahoma. Since 1991, he has taught trauma skills to other physicians as an instructor in the Advanced Trauma Life Support program. He is a member of Alpha Omega Alpha and a fellow of the American College of Emergency Physicians.

He has published three books, and frequently posts new photographs and videos on his website and social media channels. Several other television productions are in the pipeline.

In honor of Emergency Medicine Residents' Appreciation Day on March 2, an attending emergency physician offers a few tips for making the most of your residency.

By Shilpa Amin, MD, FACEP

Dr. Seuss said it best: “Congratulations! Today is your day. You’re off to great places! You’re off and away! You have brains in your head. You have feet in your shoes, you can steer yourself in any direction you choose.”
You have worked extremely hard to get into your residency program, now make the most of these important years! Each year is a stepping stone to help you find the perfect job; you are the person who’ll decide where to go.

There is no manual to surviving residency, but there are a few pieces of advice I’d like to offer.

Intern Year: Learn the basics. There is no real substitute for understanding the fundamentals of teamwork, hard work and efficient work. When you are an intern, you are working the most shifts, doing many procedures and learning to absorb direction from many people: senior residents, attendings and consultants. Take this year to really understand how the ED functions, because the operations of the ED are unique. Use this year as a base for success for the rest of your residency. Ask lots of questions. Read when you have time. And most importantly, HAVE FUN.

Junior Year: Be a mentor and true teacher to the interns. Remember the saying: “See one, do one, teach one.” You will quickly learn procedures and how to care for critically ill patients. Strive to be a strong leader in your junior year. This year you will have more time to read and more time to network.

Start talking to the seniors who just graduated and see where and how they found their jobs.

Align yourself with colleagues who work in a setting that you see yourself in (academic, community, administrative).

Attend national conferences such as ACEP, AAEM or SAEM. Visit the booths and speak to other physicians about what they like most (and least) about their jobs.

Use this year to build a foundation for your job search. Toward the end of your junior year, begin researching different employment models, consider if you want to apply for a fellowship and where geographically you want to practice. Begin drafting an initial version of your CV and have your program director and other faculty review it to help you revise.

Senior Year: This is when the job search is in full effect. Use the summer months to network, learn what an independent contractor is – speak with your accountant or adviser to see if this is the right fit for you to help better understand the job market. Reach out to alumni from your program for more information. Your program director and chairman also are great resources if you’re looking for a job in a location that you’re not familiar with. Begin thinking about who you are going to ask to fill out your references for your applications. Finalize your CV and write a cover letter. Begin sending out emails to the EDs you are interested in applying to.

September and October of senior year is when most residents start interviewing. Give yourself enough time during each interview to spend time in the ED and shadow one of the doctors for a few hours. This will give you a real sense of how the ED functions as a system and works as a team. Interview at enough places to give yourself a broader understanding of the different work environments available to you and where you would fit best. I recommend researching and preparing questions in advance of each interview. Ask for a current copy of the schedule. Be sure to fully understand compensation and scheduling, how vacations work, and what type of malpractice coverage you will have.

In November and December, review all of the information obtained from your interviews.

Ask yourself where you will be most happy and have the most successful career.

Ask your mentors to sit with you and decipher the information and assess each site.

Review your contract and have a contract attorney review it for you as well, specifically examining restrictive covenants and any confusing language.

As a courtesy, let anyone who extended an offer that you don’t accept know where you decided to start your career.

“Today is your day! Your mountain is waiting. So, get on your way!”

Shilpa Amin, MD, FACEP, is a full-time attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J. Dr. Amin also is the director of the physician recruiting team for EmCare Partners Group. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine, where she served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and three young children.

Now an attending emergency physician, Dr. Peter Lee learned the importance of choosing "the right seat" as an ED scribe.

By Peter Q. Lee, D.O.

Parking my car in the scribe lot this summer brought back a string of memories that made me reflect on my career path thus far. Perhaps the picture on the right explains it all. While the most noticeable difference might be the SpongeBob sticker that appears on my old ID card, I assure you that I have come a long way in more than just my maturity level (Well, maybe that’s open to debate!). This side-by-side comparison shows how I started my medical career: as a scribe at Saint Barnabas Medical Center in Livingston, N.J., and now, my ID card on the right, eight years later, as an attending emergency physician.

On my first day as a scribe, I got out of my car and was unsure of what to expect. Maybe my first lesson would be to memorize medical terminology, learn where to obtain EKGs or check on labs. Surprisingly, my first lesson of the day was about something that had nothing to do with medicine at all – chairs. I quickly learned to not to take anyone’s seat in the ED. While this lesson may seem simple, it’s carried me a long way in terms of making a good first impression at many hospitals during medical school and residency. It’s made me walk into each new ED with the confidence that I would not be that guy who foolishly takes a nurse’s seat.

Speaking of confidence, my time as a scribe is what solidified my resolve and gave me the courage to pursue medical school, obtain my No. 1 residency spot at Morristown Medical Center and eventually that same practice as an attending.

The Treatment Trifecta

While school taught me certain fundamentals, I was truly able to learn and apply my knowledge when doctors and nurses involved me in their work. As a scribe, I had the advantage of seeing how medical professionals made decisions under split-second time constraints, how they dealt with the pressure and how they accommodated a variety of patient personalities and cultures. In an arena where there is a surprise behind every curtain, I learned that a simple, “How can we help today?” from a doctor adds a certain routine to the task at hand, and helps show genuine care to patients when they are feeling fearful and are in need of hope.

The beloved poet Maya Angelou once said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” When I was a scribe, I saw many doctors treat patients not just physically but mentally and emotionally. As doctors, we hope that we are fortunate enough to solve every problem, but it’s not always the reality. Hence, I always remind myself that medicine also is a “people field,” and I strive to make patients feel as comfortable as possible. Five minutes behind a curtain makes a big difference in someone’s life. It’s how we use that time – to let our light shine in all circumstances.

From seeing incredible displays of bedside manner, I have learned that there is a “treatment trifecta,” and I strongly value treating patients physically, mentally and emotionally. Not only did I see how doctors interacted with patients, but I also saw how they interacted with nurses and other staff members. In this fast-paced environment, nurses and other medical staff are your teammates, but they aren’t just teammates when in action; it’s important to develop personal friendships at work. I’m blessed to have already established the basis for many personal relationships at Saint Barnabas from my days as a scribe; returning to Saint Barnabas now is like returning home.

Doctors, pharmacists, nurses, techs and cafeteria and janitorial staff all helped me get to where I am today, and for that I am truly grateful. I have realized the kind of doctor that I want to be and can now find the right seat in the ED – and I attribute it to my experience as a scribe. I plan to help new scribes avoid sitting in someone else’s seat – literally – but also help them find their own “seats” at the table as doctors or advanced practice providers, just like others have helped me.

To learn more about clinical careers, visit the Careers section of our website.

Peter Q. Lee, D.O., is an emergency medicine attending physician at Saint Barnabas Medical Center, Livingston, N.J. Dr. Lee received his bachelor’s degree at Rutgers University-New Brunswick and his doctor of osteopathic medicine degree at Touro College of Osteopathic Medicine, New York, N.Y. He completed his residency in emergency medicine at Morristown (N.J.) Medical Center, where he served as chief resident. Dr. Lee lives in Montville, N.J., with his wife. They are expecting their first child in October.

Improving patient care in the hospital where you actually practice can be challenging enough. Imagine trying to improve patient care a half a world away!

That’s exactly what Dr. Alice Tang and her cohorts within the Baylor/John Peter Smith healthcare system are doing through the STEEEP Global Institute.

STEEEP is an acronym that stands for “Safe, Timely, Effective, Efficient, Equitable and Patient-centered.” The institute’s goal is to improve healthcare quality around the world through quality improvement and leadership programs. Dr. Tang is the group’s chief medical officer for the People’s Republic of China.

“The STEEEP institute is basically a division of quality,” she explained. “At the local level, each hospital has its own STEEEP committee and we focus on different global issues. Dr. David Ballard is the president and founder of the global institute, and he’s trying to expand the program on a global level. And about three years ago, he began forming relationships with various hospitals in China.”

Tang became the liaison between Baylor and those Chinese facilities not only because of her medical skills and leadership abilities, but also in part because she speaks Mandarin. “Speaking Mandarin – it’s not necessary but it’s helpful,” she said. “Trust is a major issue in Chinese culture, so speaking the same language can help that trust build.” With the trust she and the institute have earned, Dr. Tang is working towards helping the Chinese meet their healthcare goals.

“It’s really interesting where China is right now,” she said. “They’re experiencing a real healthcare boom. One of the main priorities in that country is to elevate their healthcare and the quality of care they provide to their citizens. In addition, they have technology that is so new and ground-breaking, yet the reason they look to the U.S. or other countries but primarily to the U.S. is that they are looking at how to use this technology in the best way possible. Because technology is easy. You can just find the biggest technology and acquire that. However, to use it in efficient and effective ways to take care of patients, that’s a whole other story. And that’s what they’re really interested in.”

The primary difference between hospitals in the United States and China is that the majority of Chinese hospitals are public. “Dr. Ballard is really focused on this,” Tang said. “Improving healthcare in the hospitals that are public hospitals as opposed to fueling medical tourism.”

Tang’s meetings with the Chinese hospital administration teams, which generally happen over telephone or teleconference, are to narrow the gap between technology and utilization of that technology in ways that benefit patient care.

“In the U.S., we’re pretty advanced with our technology, but we have the processes in place to use that technology,” she explained. “In China, they may have that same technology but they don’t have the processes in place to fully take advantage of it.”

She uses as an example the state-of-the-art CT scan and MRI machines at some of China’s hospitals that are rarely used. “You think that’s really strange because their population is the largest in the world,” she said. “Their hospitals are so large –sometimes three times the larger hospitals in the U.S. So the reason all their sophisticated equipment may be under-used is because of that public system. These patients can’t afford the extra costs or extra care that isn’t covered in the public system, so they’ll often wait until they’re at death’s door before they go see a doctor.”

As she’s working on current challenges, Dr. Tang and her cohorts at STEEEP are looking ahead. There are plans for the group to launch wider uses of telesurgery, remote-controlled robotics and teleconsulting to try to improve care worldwide. The group is also hoping to continue to grow and connect with other nations. Tang mentioned the inclusion of India and the Middle East in the institute.

“If anyone is interested in becoming involved, I hope they’ll let me know!” she said. “We’re always looking for help and for new ideas!”

Tang’s interest in public health led her to earn a master’s degree in that field, prior to completing medical school at the Kirksville College of Osteopathic Medicine. She completed a residency at the University of Maryland Baltimore and she is also an emergency ultrasound fellow. Along with being an EmCare physician who functions as associate medical director for Baylor McKinney and the ultrasound director for the Baylor system, she practices clinically at the Baylor McKinney Emergency Department and periodically holds ultrasound labs for EmCare clinicians.

“All of these projects are fun!” said Dr. Tang, discussing the many hats she wears for Baylor and EmCare. “I enjoy every project that I’m on.”